Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
HNO. 2024 Jan;72(Suppl 1):25-32. doi: 10.1007/s00106-023-01342-6. Epub 2023 Sep 1.
Patients with a cochlear implant (CI) should be evaluated for a new speech processor every 6 years. The aim of this analysis was to assess the subjective and audiological benefit of upgrades.
Speech understanding and subjective benefit were analyzed in 99 patients with the old and the new speech processor after 4 weeks of wearing. Speech understanding was assessed using the Freiburg monosyllabic test in quiet (FBE) at 65 dB and 80 dB, and the Oldenburg Sentence Test (OLSA) at 65 dB noise with adaptive speech sound level. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to assess subjective hearing impairment, and the Audio Processor Satisfaction Questionnaire (APSQ) was used to assess subjective satisfaction.
The speech processor upgrade resulted in a significant improvement of speech understanding in quiet at 65 dB (mean difference 8.9 ± 25.9 percentage points, p < 0.001) and 80 dB (mean difference 8.1 ± 29.7 percentage points, p < 0.001) and in noise (mean difference 3.2 ± 10.7 dB signal-to-noise ratio [S/N], p = 0.006). Using the APHAB, a significant improvement (mean difference 0.07 ± 0.16, p < 0.001) in hearing impairment was demonstrated in all listening situations. The APSQ showed significantly higher patient satisfaction with the new speech processor (mean difference 0.42 ± 1.26, p = 0.006). A comparative assessment of the benefit based on subjective and speech audiometric results identified a proportion of patients (35-42%) who subjectively benefited from the upgrade but had no measurable benefit based on speech audiometry.
There was a significant improvement in audiologically measurable and subjectively reflected speech understanding and patient satisfaction after the upgrade. In patients with only a small improvement in audiologically measurable speech understanding, the subjective benefit should also be assessed with validated measurement instruments in order to justify an upgrade to the payers in the health sector.
植入人工耳蜗的患者应每 6 年评估一次新的言语处理器。本分析的目的是评估升级的主观和听力学获益。
在佩戴新言语处理器 4 周后，对 99 名患者的旧言语处理器和新言语处理器的言语理解和主观获益进行了分析。在 65dB 和 80dB 的安静环境下使用弗赖堡单音节测试（FBE）评估言语理解，在 65dB 噪声下使用自适应言语声级的奥登堡句子测试（OLSA）评估言语理解。使用简短听力辅助获益量表（APHAB）评估主观听力障碍，使用音频处理器满意度问卷（APSQ）评估主观满意度。
言语处理器升级可显著提高在安静环境下的言语理解能力，65dB（平均差异 8.9±25.9 个百分点，p<0.001）和 80dB（平均差异 8.1±29.7 个百分点，p<0.001），噪声下（平均差异 3.2±10.7dB 信噪比[S/N]，p=0.006）。使用 APHAB，在所有听力情况下，听力障碍都有显著改善（平均差异 0.07±0.16，p<0.001）。APSQ 显示患者对新言语处理器的满意度显著提高（平均差异 0.42±1.26，p=0.006）。基于主观和言语测听结果的获益比较评估发现，有 35-42%的患者在主观上从升级中获益，但基于言语测听无可测量的获益。
升级后，在可测听的言语理解和患者满意度方面有显著提高。对于言语理解能力仅略有提高的患者，应使用有效的测量工具评估主观获益，以便为卫生部门的支付方提供升级的依据。
